When a baby is born, the umbilical cord is cut after which blood remains in the blood vessels found in the placenta and the portion of the umbilical cord that remains attached to it. After birth, the baby no longer needs this extra blood left in the placenta and the cord. This extra blood is called placental blood or umbilical cord blood; also known as “cord blood” for short. Cord blood contains all the normal elements of blood, which include the red blood cells, white blood cells, platelets and plasma. It is also rich in hematopoietic (blood-forming) stem cells, which are similar to those found in bone marrow. These young stem cells can renew themselves and become specialized. This is the reason why during transplantation, cord blood can be used as an alternative to bone marrow.
Why should you save cord blood?
Cord blood is being used increasingly on an experimental basis as a source of stem cells. This is as an alternative to bone marrow. Numerous cord blood transplants have been performed in patients with diseases of the blood and the immune system. Cord Blood transplants have also been done for patients having genetic or metabolic diseases. More than 80 different diseases have been successfully treated to this day with unrelated cord blood transplants.
The most common category of diseases to be treated using cord blood has been leukemia. The second largest group is that of diseases which are inherited (these are of red blood cells, the immune system and certain metabolic abnormalities). Patients with lymphoma, myelodysplasia and severe aplastic anemia have also had cord blood transplants successfully. Immune deficiencies, neutrophil disorders, autoimmune diseases, and other malignancies such as breast cancer have been treated with cord blood transplants.
Investigations and further tests are being done by scientists to show the possibility that stem cells in cord blood may be able to replace cells of other tissues such as nerve or heart cells. From this research, the use of cord blood to treat other kinds of diseases will be learned.
What are the benefits of cord blood?
Cord blood has a number of benefits to the donors as well as the recipients of the transplants. It is easily collected, higher likelihood to provide a suitable match and is stored frozen, therefore ready to be put to use.
1. Cord blood collection is easy and has no medical risk to the mother or newborn baby.
Cord blood collection is a safe, simple process. The New York Blood Center’s National Cord Blood Program staff collects placental blood from the delivered placenta, in a way that does not interfere with the care of the mother or newborn baby. Collection, therefore, poses no risk to mother or the newborn.
2. Cord blood is collected in advance, tested and stored frozen, ready to be put to use.
Cord blood is gotten from donors in advance for whoever might need it in the future. All routine testing is completed and the unit is stored frozen. If a match is found, it can then be reserved. Confirmatory HLA typing and any other special testing required is usually done within 5 days. Unlike bone marrow, there is no need to take time to find a possible volunteer and then determine whether they are still willing and able to donate.
3. Cord blood transplants do not need a perfect match in order to be done.
Studies conducted have shown that cord blood transplants can be done in cases where the donor and the transplant recipient are partially matched. On the other hand, bone marrow grafts require 8/8 matching in most if not all cases.
Therefore, cord blood increases the chances of the patient’s to find a suitable donor. With cord blood, a very small donor pool can successfully support most of the patients’ needs.
4. Cord blood transplants are associated with lower incidence of GvHD.
The immune cells in cord blood seem to be less likely to attack the recipient patient’s own tissues than those in bone marrow from unrelated donors (graft vs. host disease).
5. Cord Blood Transplants are associated with lower risk of viral infections.
Cord blood transplants are less likely to transmit certain viruses, like Epstein-Barr virus (EBV) and cytomegalovirus (CMV), potentially lethal infections for transplant patients. CMV is carried as a latent virus by about half of the adult U.S. population, whereas less than 1 percent of infants are born with CMV.
Are there any cons of cord blood?
The main disadvantage of cord blood is that the amount collected is fixed and relatively small compared to other forms of obtaining stem cells such as bone marrow. Therefore, the number of stem cells readily available for transplantation is lower than the number of cells that can be collected in customizable bone marrow or peripheral blood stem cell harvests. As a consequence, engraftment to the recipient patient’s blood is slow with cord blood compared to bone marrow transplants. As a result, cord blood transplant recipients may be more vulnerable to infections in the initial months after the transplant. This problem is greatest for teenagers and adults since they need a relatively large number of cells. More about the pros and cons of cord blood banking.
A cord blood transplant may also result in the patient getting one of the rare genetic diseases of the blood or immune system. Cord blood is always tested for common genetic diseases such as hemochromatosis and sickle cell anemia. And we obtain information about diseases that the infant may have before they are sent home after birth. Nonetheless, some genetic diseases may not show in the child for days, months or years and will not be found or even suspected by current screening methods. Currently, it is not possible to test for all of these rare diseases as well. Hence, there is a chance that a cord blood transplant may transmit to a recipient a rare and serious genetic disease that was not recognized earlier.
Another limitation of cord blood is that the donor cells are collected from a newborn baby that will not be available for donation of cells or bone marrow afterwards. Conversely, in bone marrow transplants, the donor may be requested to make a donation of white blood cells to help fight a recurred case of leukemia or development of lymphoma. A second marrow donation might as well be needed if and when the first one fails to engraft. T-cell donations and second transplants from the one donor are not a possibility with cord blood. Another unit of cord blood from a different donor would have to be obtained if the first one fails.
World Legislation on Cord Blood Banking
The banking of cord blood can be compared with the production of cell transplants which should fall within the following:
• Should be sterile.
• Number of viable cells should be enough to restore the hematopoiesis and the functioning of the graft afterwards.
• Should not contain any harmful cryconservative substances
Relevant national and international committees were created in the world for the regulation of code blood banking which is of great importance. They also provide licensing terms of the code blood banks internationally. Today, up to 23 countries in the world have put in place laws requiring doctors to inform expectant ladies and parents of the possibilities of preservation of the cord blood as well as its donation to state and public blood banks.
Storage and clinical use of cord blood cells is ethical and approved by all the religions of the world. This has seen cord blood banks actively functioning in Catholic, Orthodox and Muslim countries, and India and Japan as well. The Catholic Capital of the World Vatican in the year 2010 set aside two billion euros for research of adult stem cells. In Vatican, as well, the Pontifical Council for Culture holds periodic scientific conferences devoted to modern capabilities of cell therapy and its relation to issues of culture, ethics and faith.
All over the world, stem cell therapy can be carried out only in hospitals that are licensed for this type of procedure. This is done according to protocols approved by the appropriate regulatory authorities in the field of health care in the particular nations.
The most important international organisations that oversee the clinical application of stem cells are the European Association for the Bone Marrow Transplantation (EBMT), EUROCORD, American Association of Blood Banks (AABB), Food and Drug Administration (FDA) of the U.S., World Health Organisation (WHO).